2012-08-15T13:56:41-05:00 2011-09-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2010-10-01 264812335 Dartmouth-Hitchcock Health DART 6036505000 One Medical Center Drive Lebanon NH 03756 Robin Kilfeather-Mackey 6036505668 2012-08-13 3176817000 2010 2016-02-24 21:20:13Z X JAMES WEINSTEIN One Medical Center Drive Lebanon NH 03756 3506925 false X N/A X 2009 NH To establish,manage,govern,and fundraise for an integrated health care delivery system that best serves the purposes of preventing,diagnosing treating,& curing human illness within the Northern New England Region 13 10 0 10 0 0 0 0 0 3506925 0 0 0 0 0 3506925 0 0 0 0 0 0 0 0 0 0 3506925 0 3506925 0 0 0 429837 0 429837 0 0 Dartmouth-Hitchcock Health (D-H Health), is a New Hampshire (NH) nonprofit corporation exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (IRC). D-H Health was formed in May 2009 with operations commencing on October 1, 2010. D-H Health is operated for the following charitable, educational and scientific purposes: -to establish, manage, govern, and fundraise for an integrated healthcare delivery system that best serves the purposes of preventing, diagnosing, treating and curing human illness within the Northern New England region; to manage a healthcare system that provides health care services to the public in a cost-effective manner; -to establish and maintain cooperative hospital and provider relationships throughout its system; -to achieve excellence in clinical innovations, service, quality, cost and outcomes, supported by a strong academic program; and to integrate research, training, information technology and academic medicine in the provider false false 1142969 1995679 As part of its mission to establish and maintain cooperative hospital and provider relationships throughout its systems, D-HH assisted with key elements of cooperative relationships including completion of conversion of the former Dartmouth Hitchcock Alliance into the new LLC structure for the New England Alliance for Health (NEAH), a voluntary shared services organization. New outreach specialty services were established in the D-H two-state region increasing access to needed services. Several serious provider organization requests to D-HH for relationship exploration were responded to, some resulting in continued growth of the D-H system. 607414 1237462 Major D-HH initiative was to pursue an integrated relationship between the D-H Manchester physicians and other Southern NH non-D-H clinics and healthcare providors. Key rationale for strategy - improve the health of the population served in the region by reducing costs and improving the quality of care. Some of the key expectations - reduction of administrative costs, improved health information exchange resulting in improved clinical outcomes and the establishment of a platform to allow participation in innovative reimbursement models. 204111 273784 Planning processes were implemented to advance Medical Homes and to lay the foundation for development of an Accountable Care Organization (ACO) model. Medical Homes and ACOs require the investment of resources to design systems to reduce costs, to improve the quality of care in a measureable way and ultimately to reflect improvement in the health of the population. To support these efforts, an intensive planning process was undertaken to achieve a transformational change in the clinical information systems for the D-H system. 1954494 true false false false false false false false false true false false false false true true false false false false false false false false false false false false true false false false false false false false false false false false false false true true true false false true X 5 0 true 0 false false false false false false false false false false X 13 10 false false false false false false false true true false false true true true true true true false false false NH X ROBIN KILFEATHER-MACKEY 6036533580 ONE MEDICAL CENTER DRIVE Lebanon NH 03756 X Stephen Barba 1.0 X 0 0 0 Thomas A Colacchio MD 10.0 X X 0 735805 56310 Vincent S Conti 1.0 X 0 0 0 Nancy A Formella MSN RN 1.0 X 0 783533 28191 Michael J Goran MD 1.0 X 0 0 0 Alfred L Griggs 1.0 X 0 0 0 Alan C Keiller 2.0 X X 0 0 0 Jennie L Norman 2.0 X X 0 0 0 Anne-Lee Verville 1.0 X 0 0 0 Wiley Souba MD ScD 1.0 X 0 0 0 Wayne G Granquist 2.0 X X 0 0 0 James N Weinstein DO MS 1.0 X 0 728386 23001 William W Helman IV 1.0 X 0 0 0 Sherri Oberg 1.0 X 0 0 0 Carl Dematteo 5.0 X 0 570672 26593 Robin Kilfeather-Mackey CPA 5.0 X 0 375702 21496 Stephen Leblanc 10.0 X 0 475512 28446 John Butterly 10.0 X 0 500322 62741 0 4169932 246778 0 false true false Covington Burling LLP Legal Svcs 405551 1 0 MEMBER ASSESSMENTS 900099 3506925 3506925 3506925 0 0 0 0 0 0 0 0 3506925 3506925 0 0 0 0 0 0 0 0 0 0 0 556415 519507 36908 98000 98000 0 0 0 2696463 1278940 1417523 7500 7500 27327 27327 0 0 68483 68483 25422 25422 0 0 0 0 14872 14872 12443 12443 3506925 1954494 1552431 0 0 283439 0 0 0 0 0 0 0 0 161270 14872 0 146398 0 0 0 429837 0 429837 0 0 0 429837 X 0 0 0 0 0 0 0 0 0 429837 0 0 X false true true X false X 0 0 0 0 0 0 3506925 X 100830 8402 92428 60440 6470 53970 146398 0 0 3506925 3506925 0 0 0 3506925 0 0 3506925 0 0 3506925 3506925 0 0 3506925 0 0 3506925 Schedule D Part X Question 2 ASC 740 Audited Financial Statement Footnote Disclosure D-H Health is a nonprofit corporation as described in Section 501(c)(3) of the IRC and is exempt from both federal and state income taxes on related income pursuant to Section 501(a) of the IRC. D-H Health applies the provisions of ASC 740-10, Accounting for Uncertainty of Income Taxes, which addresses accounting for uncertainties in income taxes recognized in an entitys financial statements and prescribes a threshold of more-likely-than-not for recognition of tax positions taken or expected to be taken in a tax return. ASC 740-10 also provides guidance on measurement, classification, interest and penalties, and disclosure of tax uncertainties. Management has evaluated ASC 740-10 and there is no impact to D-H Healths financial statements for the year ended September 30, 2011. false true false false false false false false Thomas A Colacchio MD 0 676930 0 0 0 58875 0 31410 0 24900 0 792115 0 0 Nancy A Formella MSN RN 0 666246 0 0 0 117287 0 9188 0 19003 0 811724 0 0 James N Weinstein DO MS 0 672112 0 0 0 56274 0 0 0 23001 0 751387 0 0 Carl Dematteo 0 490025 0 0 0 80647 0 8820 0 17773 0 597265 0 0 Robin Kilfeather-Mackey CPA 0 363950 0 0 0 11752 0 8820 0 12676 0 397198 0 0 Stephen Leblanc 0 446635 0 0 0 28877 0 8820 0 19626 0 503958 0 0 John Butterly 0 447775 0 7500 0 45047 0 39740 0 23001 0 563063 0 0 Supplemental Retirement Information Schedule J, Part III - line 4b The following individuals received payments from a supplemental nonqualified retirement plan: Thomas Colacchio $58,875 Nancy Formella $112,157 James Weinstein $53,387 Carl Dematteo $71,527 Robin Kilfeather-Mackey $7,482 Stephen Leblanc $23,676 John Butterly $40,093 Dartmouth-Hitchcock Supplemental Retirement Plan Terms and Conditions: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including two qualified defined benefit plans) who would be entitled to additional contributions or benefit accruals under the terms of the Plans for the plan year, but are limited by IRC Section 401 (a)(17) and/or 415. For eligible employees, the Employer will pay the eigible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC Sections 401(a)(17) and/or 415. Delegation of Committees Part VI Section A Question 3 During Fiscal Year 2011, the D-HH Board delegated certain financial, audit and compliance oversight to the Finance and Audit Commmittee as well as the Compliance Committees of the joint boards of trustees of Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic, acting jointly as Dartmouth-Hitchcock ("D-H"). In addition, the D-HH Board delegated to D-H, acting through its Boards and appropriate committees and staff, the obligation to oversee the clinical activities and research of D-H and its operations in accordance with current D-H policies and procedures, including those for managed care contracting, quality of care, and research programs and affiliations which policies the Board hereby approves and endorses, provided that any significant change to such policies will be submitted to the Board for approval. The D-HH board continues to retain final management powers and decisions pursuant to Section 3.9.2 of the Corporation's Bylaws. Process used by management and/or Governing Body to Review 990 Form 990, Part VI, Line 11b The Audit Committee of the D-HH Board of Trustees is presented with a substantially complete Form 990. The Committee members review these forms before the meeting. AT THE MEETING A HIGH-LEVEL PRESENTATION IS MADE BY THE ORGANIZATION'S TAX ADVISOR AND THE ORGANIZATION'S FINANCE STAFF, WITH TIME ALLOTTED FOR QUESTIONS FROM THE COMMITTEE. ONCE THE RETURN HAS BEEN FULLY PREPARED A FINAL 990 ELECTRONIC VERSION IS SENT OUT TO EACH BOARD MEMBER PRIOR TO THE OFFICIAL FILING. THE FORM 990 IS ALSO REVIEWED BY THE DIRECTOR OF CORPORATE FINANCE, VICE PRESIDENT OF CORPORATE FINANCE AND THE CHIEF FINANCIAL OFFICER BEFORE THE FILING OF THE RETURN. Conflict of Interest Policy Form 990 Part VI Section B Line 12C The Dartmouth-Hitchcock Health Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. The Dartmouth-Hitchcock Compliance and Audit Services Department conducts an annual survey of all officers and trustees and performs other procedures as considered necessary to report on compliance with the conflict of interest policy. The Compliance and Audit Services Department then reports to each board any potential conflicts for their review. Per the policy, any conflicts or otherwise perceived conflicts are required to be addressed by the Board of Trusteees on an ongoing basis. In the event a conflict arises, the individual may be removed from participating in any decision making regarding the identified conflict and/or its corresponding transactions. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM SUCH PERSON ON THE BASIS FOR SUCH BELIEF AND AFFORD HIM/HER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INTERESTED PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT SUCH PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. Delegation of Oversight Part XII Question 2c During Fiscal Year 2011, the D-HH Board delegated certain financial, audit and compliance oversight to the Finance and Audit Commmittee as well as the Compliance Committees of the joint boards of trustees of Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic, acting jointly as Dartmouth-Hitchcock ("D-H"). The D-HH board continues to retain final management powers and decisions pursuant to Section 3.9.2 of the Corporation's Bylaws. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Thomas A. Colacchio, MD TITLE:Ex-Officio, D-HH President HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Nancy A. Formella, MSN, RN TITLE:Ex-Officio, MHMH President HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James N. Weinstein, DO, MS TITLE:Ex-Officio, DHC President HOURS:60 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carl Dematteo TITLE:Chief Qual and Compl Officer HOURS:55 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Robin Kilfeather-Mackey, CPA TITLE:Chief Financial Officer HOURS:55 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Stephen Leblanc TITLE:Exec VP D-H Health HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:John Butterly TITLE:Exec VP of Med Affairs D-HH HOURS:50 Dartmouth-Hitchcock Clinic One Medical Center Drive Lebanon NH 03756 222519596 Phys Svcs NH 501(c)3 9 D-HH Mary Hitchcock Memorial Hospital One Medical Center Drive Lebanon NH 03756 020222140 Hospital NH 501(c)3 3 D-HH false false false false false false false false false false false false false false true true false Mary Hitchcock Memorial Hospital O 3560690 Mary Hitchcock Memorial Hospital P 4556260